Individual provider Active NPI

Maria Suzanne Kaczmarek Baum, RN

  • Family Nurse Practitioner
  • Columbus, OH
National Provider Identifier
1104612571
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209.033118 Issued in IL
Practice address
1577 Neil Ave
Columbus, OH 43201-2320
Phone
(563) 564-0418
NPI assigned
Apr 15, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 209.033118 IL Primary
Registered Nurse 163W00000X 041571182 IL

Addresses

Primary practice location

1577 Neil Ave
Columbus, OH 43201-2320

Mailing address

1577 Neil Ave
Columbus, OH 43210-1216

Other practice location 1

40 75th St
Willowbrook, IL 60527-2325
Phone (630) 581-6372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251118001799 IL Practitioner - Nurse Practitioner 8022509009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Express Care 2, IncGroup PAC ID 0547495467, 221 clinicians

Practice addresses (Care Compare)

40 75TH St
Willowbrook, IL 60527-2325
Phone (630) 581-5372

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
041571182ILMDRegistered Nurse
209.033118ILMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Express Care 2, Inc CurrentSince Sep 3, 2025 Accepting new patients
Midwest Express Care 2, Inc Single Specialty CurrentSince Sep 3, 2025 Accepting new patients

Locations

40 75th St
Willowbrook, IL 60527
Phone (630) 326-5312

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1744675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1104612571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1577 NEIL AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1577 NEIL AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432012320",
            "telephone_number": "563-564-0418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 75th St",
            "address_purpose": "LOCATION",
            "city": "Willowbrook",
            "state": "IL",
            "postal_code": "605272325",
            "country_code": "US",
            "telephone_number": "630-581-6372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUM",
        "first_name": "MARIA",
        "middle_name": "SUZANNE KACZMAREK",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-15",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.033118",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041571182",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.